The coronavirus disease 2019 (COVID-19) pandemic remains threatening to women and children, but clinical evidence regarding women during pregnancy, puerperium and lactation is limited. We assessed clinical and immunologic features of and breastfeeding advice provided to mother–infant pairs. This observational analysis was conducted in a tertiary-care centre in Wuhan, China. Pregnant patients with laboratory-confirmed COVID-19 who delivered during hospitalization were enrolled. Clinical characteristics and serial specimens of the mother–infant pairs were examined, supplemented with follow-ups regarding recovery and breastfeeding. Fourteen pregnant patients had live births and recovered well; four patients continued breastfeeding while taking precautions. No neonatal infections were observed. No infants developed COVID-19 during breastfeeding. Common maternal symptoms were fever (11/14, 78.1%) and cough (6/14, 42.9%). A pregnancy-specific symptom was abnormal foetal movement, which was noticed by three patients (21.4%). The mean virus shedding time was 9 days (standard deviation, 6 days; range, 1–22 days). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome was not detected in breast milk or maternal vaginal secretions. Immunologic assay revealed seroconversion of IgM on day 8 after onset and IgG on day 28. Both IgM and IgG antibodies to SARS-CoV-2 were detected in breast milk, cord blood and neonatal serum. The study results suggest that passive acquisition of antibodies against SARS-CoV-2 is available by ingesting breast milk. Breastfeeding has a low risk of transmitting SARS-CoV-2 or escalating maternal disease, so continuing breastfeeding with prudent precautions is encouraged.
Adipose tissue plays a key role in the development of insulin resistance and its pathological sequelae, such as type 2 diabetes and non-alcoholic fatty liver disease. Dysfunction in the adipose tissue response to storing excess fatty acids as triglyceride can lead to adipose tissue inflammation and spillover of fatty acids from this tissue and accumulation of fatty acids as lipid droplets in ectopic sites, such as liver and muscle. Extracellular vesicles (EVs) are released from adipocytes and have been proposed to be involved in adipocyte/macrophage cross talk and to affect insulin signaling and transforming growth factor β expression in liver cells leading to metabolic disease. Furthermore EV produced by adipose tissue-derived mesenchymal stem cells (ADSC) can promote angiogenesis and cancer cell migration and have neuroprotective and neuroregenerative properties. ADSC EVs have therapeutic potential in vascular and neurodegenerative disease and may also be used to target specific functional miRNAs to cells. Obesity is associated with an increase in adipose-derived EV which may be related to the metabolic complications of obesity. In this review, we discuss our current knowledge of EV produced by adipose tissue and the potential impact of adipose tissue-derived EV on metabolic diseases associated with obesity.
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